A recent letter from the aged care commissioner to Te Whatu Ora Health New Zealand (HNZ) detailed Southland’s lack of access to appropriate dementia and psychiatric care, as reported by the Otago Daily Times yesterday.
The clinician who raised the concerns with the commissioner said he was the only psychogeriatrician serving the area, and did not live there but flew in to work for three days every two weeks.
Prof Barak said aged care psychiatry was a problem not only for Southland but also for Otago,
"It is painful to see that's where we are at," he said.
Increasing pressure on the service had caused a brilliant colleague to leave for more accommodating work in Wellington, he said.
Dunedin had just one FTE psychogeriatrician — himself and one other person. Neither worked for the service full time.
"You don't have to be the minister of health to understand that this is just impossible ... We're just rushing from one crisis to another.
"Even if we are criminally understaffed, we should have 4 FTE according to internationally published standards."
Compared to other parts of the country, the Southern District Health Board — now HNZ Southern — had underinvested in the service.
In Christchurch, Wellington or Hawke's Bay staff were better paid and had a more reasonable workload.
While money was not the solution for everything, it would certainly help.
"If you want to set up a short-term plan, you need to invest a lot of money in retaining the people who are here and making sure that they can go to their daily tasks which are are enormous compared with other DHBs".
The 12 psychogeriatric beds cut from the new Dunedin hospital last December were reinstated to the build in September.
This followed Health Minister Ayesha Verrall’s announcement earlier this year that the cut beds, as well as the loss of pathology space, would be the subject of reviews.
Prof Barak said this was better than nothing, and he was pleased the demand had been acknowledged.
However, more beds would be needed as the population aged, as well as more staff.
People struggling example schizophrenia, bipolar disorder, and intellectual disability now had a better life expectancy.
Ageism was also an issue, whether consciously or unconsciously.
Although people were having fewer children, no one would dare start a conversation about cutting down on paediatric services, and it was concerning older people were viewed differently, he said.
HNZ Southern group director of operations Hamish Brown said the Southland mental health team had one FTE vacancy for a psychogeriatrician, and confirmed it was currently served by one part time locum.
"The Dunedin mental health team has 1.0 FTE mental health service for older people psychiatrists and 1.0 FTE vacancy."
"Southern has a multi-disciplinary team who work to co-ordinate care for our older people while they are in hospital and in their transition to community care.
"This includes nurses, social workers, occupational therapists, needs assessment teams, and community providers."
There were clear areas for improvement in health care for older people needing psychogeriatric care, he said.
A response received by the ODT last week following an Official Information Act request for the psychogeriatric review revealed it had not taken place.
HNZ’s response said the pathology review had resulted in the decision to build a separate pathology building, freeing up space to reinstate the beds.
"This outcome meant the [psychogeriatric] review itself was no longer immediately required and will be recommended at a later date."
No specific timeframe for this has been set.
The scope of the proposed review was much broader than the new Dunedin hospital and was intended to develop a national model of care, HNZ said.